- Intracytoplasmic sperm injection
Intracytoplasmic sperm injection (ICSI, pronounced "eeksee" [ [http://www.drmalpani.com/oligospermia.htm drmalpani.com] ] ) is an "in vitro" fertilization procedure in which a single sperm is injected directly into an egg. This procedure is most commonly used to overcome male
infertilityproblems, although it may also be used where eggs cannot easily be penetrated by sperm, and occasionally as a method of in vitro fertilization, especially that associated with sperm donation.
The procedure is done under a
microscopeusing multiple micromanipulation devices ( micromanipulators, microinjectorsand micropipettes). A holding pipette (on the left of picture) stablizes the mature oocyte. From the opposite site a thin, hollow needle is pierced through the oolemmaand into the inner part of the oocyte. It is loaded with a single sperm that will be released into the oocyte. The pictured oocyte has an extruded polar bodyat about 12 o'clock indicating its maturity. After the procedure, the oocyte will be placed into cell culture and checked on the following day for signs of fertilization.
In natural fertilization sperm compete and when the first sperm enters the egg cell, the egg cell blocks the entry of any other sperm. Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without any specific testing. However, in mid 2006 the FDA cleared a device that allows embryologists to select mature sperm for ICSI based on sperm binding to
hyaluronan, the main constituent of the gel layer ( cumulus oophorus) surrounding the oocyte. The device provides microscopic droplets of hyaluronan hydrogel attached to the culture dish. The embryologist places the prepared sperm on the microdot, selects and captures sperm that bind to the dot. Basic research on the maturation of sperm shows that hyaluronan-binding sperm are more mature and show fewer DNA strand breaks and significantly lower levels of aneuploidythan the sperm population from which they were selected.
There is some suggestion that
birth defectsare increased with the use of IVF in general, and ICSI specifically, though results of different studies differ. In a summary position paper, the Practice Committee of the American Society of Reproductive Medicine has said it considers ICSI safe and effective therapy for male factor infertility, but may carry an increased risk for the transmission of selected genetic abnormalities to offspring, either through the procedure itself or through the increased inherent risk of such abnormalities in parents undergoing the procedure. [Genetic considerations related to intracytoplasmic sperm injection (ICSI). Fertility and Sterility, Volume 86, Issue 5, Pages S103 - S105. [http://linkinghub.elsevier.com/retrieve/pii/S0015028206033711] ]
* [http://www.epigenome-noe.net/ The Epigenome Network of Excellence (NoE)]
* [http://www.hfea.gov.uk/ The Human Fertilisation and Embryology Authority (HFEA)]
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